The Milk River, originating in Montana's Glacier County, flows northward into Alberta, Canada before turning southeast and re-entering Montana, eventually joining the Missouri River. This unique U-shaped international watercourse spans approximately 729 miles (1,173 km), with its primary watershed covering parts of Montana and southern Alberta. Paddling on the Milk River is primarily concentrated in the Alberta section, offering a mix of scenic prairie landscapes and challenging rapids. The most popular route runs from the town of Milk River to Writing-on-Stone Provincial Park, a distance of about 33 miles (53 km). This section typically takes 3 days to complete and is rated as Class II-III, suitable for intermediate paddlers with competent maneuvering skills in fast water.

The river's difficulty ranges from Class I to III, with the upper sections featuring midstream rocks and sharp turns that require careful navigation. Paddlers should be prepared for large rocks and fast turns around cliff bands, especially in the stretch from Coffin Bridge to Writing-on-Stone. The best time for paddling is typically late spring to early summer when water levels are optimal. By August, water levels can drop significantly, making some sections impassable.

The Milk River flows through unique prairie and badlands ecosystems, home to diverse wildlife including pronghorn antelope, mule deer, and various bird species. The river corridor is known for its striking sandstone formations and hoodoos, particularly visible in Writing-on-Stone Provincial Park. Key landmarks include Gold Springs Campground, Coffin Bridge, Poverty Rock, and Writing-on-Stone Provincial Park. The park is particularly significant, featuring ancient Indigenous rock art and serving as the endpoint for many trips.

Popular access points include the town of Milk River, Gold Springs Campground, and Coffin Bridge. The nearest major city is Lethbridge, Alberta, about 65 km northwest of the town of Milk River. The river holds great historical and cultural significance, particularly for Indigenous peoples who have inhabited the area for thousands of years. The rock art at Writing-on-Stone is a testament to this rich heritage.

Safety considerations include being prepared for remote wilderness, potential extreme weather, and challenging water conditions. Paddlers should be self-sufficient and carry appropriate safety gear. Multi-day trip options are common, with the most popular being the 3-day journey from Milk River town to Writing-on-Stone. Longer trips can start as far upstream as Whisky Gap, covering up to 82 miles over 4-5 days.